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CardioPulm > Cardiac Exam 1 > Flashcards

Cardiac Exam 1 Flashcards

1
Q

what forms the sternocostal surface of heart?

A

right atrium and ventricle

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2
Q

what forms the diaphragmatic surface of heart?

A

left and right ventricles

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3
Q

what forms the posterior surface of the heart?

A

mostly left atrium; some right atrium. also called the base of the heart

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4
Q

what is the apex of the heart?

A

left ventricle

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5
Q

where would you hear mitral valve closing?

A

apex; fifth rib at mid clavicular line

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6
Q

location of base of heart

A

third rib; where the great vessels are

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7
Q

where can endocarditis pain be felt?

A

low back pain

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8
Q

what is acute mitral regurgitation?

A

during left heart failure; L ventricle gets bigger; papillary muscles move farther away from valve; which can cause cordae tendinae to rupture

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9
Q

what is functional syncytium

A

group of cells acting as one unit; atria contract together; ventricles contract together

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10
Q

inherent pace of SA node

A

60-100 bpm; most unstable resting potential; easiest to depolarize; and repolarizes quickly

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11
Q

inherent pace of AV node

A

40-60 bpm

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12
Q

inherent pace of ventricles

A

20-40 bpm

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13
Q

what does the tricuspid valve separate?

A

right atrium and ventricle

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14
Q

what does the mitral valve separate?

A

left atrium and ventricle

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15
Q

how much does the atria contracting contribute to ventricular filling?

A

20-30%

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16
Q

when do coronary arteries fill?

A

right after valves close; ventricular diastole

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17
Q

what does the right coronary artery supply?

A

Right atrium and ventricle; inferior and posterior portion of L ventricle; posterior 1/3 of interventricular septum; SA (55% of ppl) and AV node; bundle of His; posterior fascicle of left bundle branch

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18
Q

what does LAD supply (left anterior descending branch of coronary artery)

A

anterolateral left ventricle; anterior 2/3 of septum; most of right bundle branch; anterior fascicle of left bundle branch; part of posterior fascicle of left bundle branch

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19
Q

what does Cx supply (circumflex branch of left coronary artery)

A

Left atrium; anterolateral and posterolateral left ventricular wall; SA node in 45% of ppl

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20
Q

A-VO2 difference in skeletal and cardiac muscle at rest

A

skeletal: 25%
cardiac: 70-80%

increased by increased blood flow

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21
Q

what does the SNS do to vessels?

A

vasoconstrict! Tissues in use vasodilate in response to local factors (nitric oxide) released from working cells

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22
Q

what fuel does cardiac muscle prefer at rest?

A

fatty acids; but will use anything.

heart helps to clear lactate during heavy exercise

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23
Q

heart rate changes during heart failure

A

increased

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24
Q

beta 1 receptors

A

sympathetic control to heart

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25
Q

alpha receptors

A

sympathetic control (vasoconstriction) in periphery

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26
Q

beta 2 receptors

A

sympathetic control in coronary arteries; vasodilate

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27
Q

normal range for potassium

A

3.5 - 5 mEq/L

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28
Q

biggest influencer of afterload

A

vasular resistance

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29
Q

resting ejection fraction

A

50-60%

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30
Q

atrial stretch reflex

A

causes diuresis on bedrest

increases atrial naturetic factor; decreases ADH and renin

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31
Q

coronary blood flow driving pressure

A

systemic diastolic pressure-left ventricular end diastolic pressure

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32
Q

ideal left ventricular end diastolic pressure

A

less than 12

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33
Q

why would diastolic pressure increase with exercise?

A

coronary artery disease; increasing diastolic pressure increases driving pressure to increase perfusion to heart

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34
Q

what is rate pressure product

A

heart rate * systolic blood pressure

measure of the O2 demand on heart; decreases at a given workload with training

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35
Q

normal p-r interval

A

0.12-0.20; 3-5 little boxes

36
Q

box size on ecg

A

small boxes: 0.04s

big box: 0.2s (5 small boxes)

37
Q

normal QRS duration

A

0.06-0.10 sec

38
Q

what can cause ST elevation/depression?

A

supply or demand of O2

39
Q

what can inverted T wave mean?

A

ischemia

40
Q

what part of ecg changes with exercise?

A

QT interval - onset of ventricular depolarization to end of repolarization

41
Q

Mean Arterial Pressure

A

average blood pressure; normal 70-110.

42
Q

normal hemoglobin

A

12-17; lower in females

43
Q

normal hematocrit

A

36-51% lower in females

44
Q

SVO2

A

venous oxygen saturation; measured by central catheter; shouldn’t drop more than 10% with exercise; should go back up in 3 min

45
Q

beginning of coronary artery disease

A

endothelial damage precedes morphological changes; decreases nitric oxide

46
Q

EDRF

A

endothelial derived releasing factor (nitric oxide)

47
Q

goal for cholesterol numbers

A

less than 200 total
LDL less than 100
HDL>50-60
TC/HDL>4.5

48
Q

amount of exercise that vastly decreases mortality

A

even just 1 mile/day is not much better than 8 mile/day

49
Q

hemocystene

A

lower is better; high levels lead to endothelial damage; tends to be high in ppl with hypertension

50
Q

S3 heart sound

A

early sign of CHF; extra sound after S2; can be brought on by exercise; normal in young (less than 40) aerobically trained ppl; may have in supine because of increased venous return

51
Q

S1 heart sound

A

systolic sound; mitral and tricuspid valve closing

52
Q

S2 heart sound

A

pulmonary and aortic valves closing; ventricular diastole

53
Q

S4 heart sound

A

atrial gallop; heard before S1

54
Q

“hemodynamic significance”

A

what effect does the variable have on cardiac output

55
Q

what does a weak pulse indicate?

A

low stroke volume or increased peripheral resistance

56
Q

bradycardia during exercise

A

usually sign on severe CAD or heart block

57
Q

RPE of lactate threshold

A

13; most ppl will self select this level for a workout/run

58
Q

heart rate recovery post exercise

A

max exercise HR-HR after 1-2 min of recovery; >12 beat decrease within first minute normal

59
Q

hypertension

A

Systolic >140mmHg

60
Q

blood pressures to not exercise

A

systolic >200 or less than 80;
diastolic >110
esp/or if it is really different than their normal

61
Q

normal BP response to exercise

A

Systolic increase 7-10mmHg/MET
little to no change in diastolic
BP will increase more with resistance exercise vs. endurance

62
Q

pulse pressure

A

systolic-diastolic

normally >20; good 30-40

63
Q

exercise recommendations for Hemoglobin

A

less than 8 g/dl: only essential ADL’s as long as not symptomatic
8-10: light aerobics; light weights
>10: ambulation and resistance exercise as tolerated

64
Q

exercise recommendations for Hematocrit

A

less than 25%: only essential ADL’s as long as not symptomatic
25-35%: light aerobics; light weights
>35%: ambulation and resistance exercise as tolerated

65
Q

INR

A

international normalized ratio; measure of clotting time
normal 0.9-1.1
normally higher when on cumodin or DVT aFib; 2.3-3.5 for mechanical valves

66
Q

INR and exercise

A

INR less than 4: perform regular PT and OT; delay increasing intensity
INR 4-5: no resistive exercise; RPE5: no exercise; may transfer
INR >6: may be on bed rest

67
Q

immediate signs and symptoms to stop exercise

A

S3 onset; abnormal BP response; 2nd or 3rd degree heart block; lightheaded/dizzy

peak exercise HR should be 10bpm below symptoms

68
Q

what is the first test performed to diagnose valve problems

A

echocardiogram/ultrasound; also estimates stroke volume and ejection fraction; can add doppler to look at blood flow velocities

69
Q

PET scan

A

nuclear; measure metabolism of heart and myocardial perfusion; is the injury reversible? Can add Dipyridamole to vasodilate coronary arteries to get a better idea of how good coronary artery blood flow is

70
Q

spiral CT

A

detects coronary calcification (part of plaque); aortic aneurysm; pericardial thickening; masses

71
Q

SPECT

A

single photon emission computed tomography; usually do echo first; detects perfusion and contractility defects

72
Q

EBCT

A

electron beam computed tomography; detects calcium in coronary arteries; quantify athersclerosis

73
Q

MUGA

A

multigated acquisition imaging; inject tagged blood and track it to caclulate ejection fraction

74
Q

MRI for cardiac diagnoses

A

used to detect coronary artery obstruction; wall movement abnormalities; valve disease; cardiac blood flow

75
Q

Radionuleotide studies

A

inject radioactive labeled agents which is taken up by tissues; looking for “cold spots” where material isn’t taken up indicating lack of blood flow and ischemia; inject just before end of exercise scan then and again 4 hours later to assess if damage is still there; if it is damage is likely permanent

76
Q

pharmacologic stress testing

A

Dipyridamole vasodilates; used when person is unable to do exercise test

77
Q

coronary angiography

A

catheters inserted into coronary arteries with injection of contrast material; determines location of lesion; degree of obstruction; presence of collateral circulation; extent of disease in distal artery bed

78
Q

ventriculography

A

contrast material injected into ventricle to visualize how well heart wall moves

79
Q

arterial line implications for PT

A

don’t do ROM to kink line; sometimes don’t get out of bed with femoral line; pressure is calibrated with R atrium at level of transducer; for every inch away from this level BP will be ~2mmHg higher or lower

80
Q

pulmonary artery catheter

A

usually inserted into R jugular vein; can inject bolus of cold fluid to measure cardiac output

81
Q

pulmonary capillary wedge pressure

A

balloon inflated and floats until it gets stuck in lung; pressure pushing back is theoretically the same as the left ventricular diastolic pressure; if wedge pressure is high would be concerned that driving pressure is low; normal 4-12mmHg

82
Q

normal right atrial pressures

A

0-8mmHg

83
Q

normal right ventricular pressures

A

systolic 15-30mmHg

diastolic 0-8mmHg

84
Q

normal pulmonary artery pressures

A

systolic 15-30mmHg

diastolic 5-15mmHg

85
Q

cardiac index

A

cardiac output/sq meter

3.5L/min/m2 normal

86
Q

Intra-aortic balloon counterpulsation

A

assistive device for the heart; increases coronary blood flow; inserted into femoral artery (or axillary) to aorta just distal to left subclavian orifice; inflates during diastole; no hip flexion past 15-30 deg could push balloon proximal and block blood flow to UE

CardioPulm (3 decks)

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